Provider Demographics
NPI:1366818361
Name:CASH, COLLEEN MARIE (LCSW, LMSW)
Entity Type:Individual
Prefix:MISS
First Name:COLLEEN
Middle Name:MARIE
Last Name:CASH
Suffix:
Gender:F
Credentials:LCSW, LMSW
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:CASH
Other - Last Name:RUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 CANDLEWOOD RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-3210
Mailing Address - Country:US
Mailing Address - Phone:513-604-4565
Mailing Address - Fax:
Practice Address - Street 1:1720 CANDLEWOOD RIDGE LN
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-3210
Practice Address - Country:US
Practice Address - Phone:513-604-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-13
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0126661041C0700X
SC123191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSW1650Medicaid